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Immunotherapy for Bladder Cancer

Immunotherapy is sometimes used to make the body's own immune system fight cancer.

Immunotherapy is sometimes called biological therapy. For this therapy, drugs are used to make the body’s own immune system fight cancer. Its goal is to kill cancer cells without having to remove the bladder. It can also help keep the bladder cancer from coming back.

Your doctor may recommend immunotherapy if you have early stage, superficial bladder cancer. This means the cancer has not spread beyond the lining of your bladder.

What happens during immunotherapy for bladder cancer

The most common way to give immunotherapy for bladder cancer is intravesically. That means the drugs are placed directly into your bladder instead of injected into your blood or taken as pills. Early-stage bladder cancer can often be successfully treated with the drug BCG (bacillus Calmette-Guerin). The doctor puts BCG directly into your bladder by inserting it through a catheter in your urethra. Your body’s immune system responds to the presence of BCG and the bladder cancer cells are destroyed.

You go to your doctor’s office to have intravesical immunotherapy. For the eight to 12 hours before the treatment, you should drink only a small amount of water. In the last four hours before the treatment, you should drink no liquids. Your bladder needs to be almost completely emptied for BCG to work.

Your doctor inserts a catheter through your urethra into your bladder. This usually isn’t painful, although you will feel some discomfort when the catheter goes through the urethra. Any urine remaining in the bladder drains out through the catheter. Then your doctor injects the drug into the catheter.

You should do your best not to urinate for at least two hours after the drugs are put into your bladder. This allows the drugs to stay in your bladder long enough to kill cancer cells. You will lie flat during this time, and will be asked to change position occasionally to make sure the drugs reach all parts of the bladder lining. After you urinate, the drugs will come out of the bladder in your urine.

Because BCG is made up of live bacteria, it is very important that you follow instructions carefully about handling your urine after receiving the treatment. Wash your hands after urinating. You may be instructed to add bleach to the toilet water for the first few hours after the treatment to kill the bacteria in the urine.

Your doctor will ask you to drink a lot of water starting about two hours after the procedure. This will dilute the drug that remains in your bladder and reduce bladder irritation, fever, and other potential side effects.

You usually have six weekly treatments initially. Follow-up treatment is generally scheduled over the next 12 to 24 months. Follow-up treatments may be given once a month or less frequently (for example, every three months).

What to expect after immunotherapy for bladder cancer

Here are some of the side effects that are common with immunotherapy for bladder cancer:

Discomfort or burning in the bladder

Feeling the need to urinate often

Flu-like symptoms, such as chills, fatigue, or fever

These side effects usually go away within a few days after the treatment.

It's normal to have a slight fever after immunotherapy. However, if you have a lingering fever of 101.5 degrees or higher or other symptoms that last for more than two days, call your doctor. It could be a sign of infection.